What are the main IVF protocols used in NZ?

First, it’s good to know roughly what’s out there, and that there is more than one option, so that you can get your specialist to explain why this one and why not that.

Second – if you don’t do well on one protocol you may do fine on another.

Some women will need a few tries to find their “Goldilocks” (just right) protocol, but because most of us have only limited finances and stamina, it’s important to make sure you’re satisfied the first one is a good choice for you.

Basically there are three main protocols used by NZ clinics (plus a few variations, which I’ll try to add later):

1. The ‘long’ protocol (default for young women and those with normal FSH; not generally used on high FSHers unless they are quite young, and seldom on anyone over 40 because it can easily oversuppress those with diminished ovarian reserve).

Buserelin for about 10 days to downregulate (put you into temporary menopause), then the Buserelin dose is lowered and you start stims (Gonal F injections), stim for about 10 days with scans and blood tests every 2-3 days. When your follies are ready, you are instructed to take a trigger injection and turn up for egg collection about 36 hours later.

2. The microdose flare – usual starting protocol for high FSHers and women over 40. It’s less likely to oversuppress poor responders than the long protocol.

Usually but not always starts with a course of BCPs (birth control pills) for about three weeks, then you stop for a couple of days, then start your microdose course of Buserelin (this gives your ovaries a kickstart or ‘flare’), then a day or two later you start your stims (Gonal F injections). As with the long protocol, you stim for about 10 days with scans and blood tests every 2-3 days. When your follies are ready, you are instructed to take a trigger injection and turn up for egg collection about 36 hours later.

3. The antagonist protocol – another option for high FSHers, poor responders and older women. Often the first choice protocol for these women, but in NZ it’s typically tried only after the flare protocol has given a weak response because the drugs are cheaper for the flare.

Usually starts with a mild pre-cycle suppression course of estradiol valerate (E2V) from CD21 or 7dpo the previous cycle (you can ttc on your own the previous cycle; this won’t affect a pregnancy); when AF (your period) arrives this is counted as Day 1 and you may be asked to go in for a baseline scan to check that you have no cysts, your antral follicles are ready to go and no big dominant follicles; on CD2 you start stimming, having bloods and scans every 2-3 days. When your lead follicle reaches 14mm, you start Cetrotide (the antagonist that stops you ovulating too soon). When your follies are ready, you are instructed to take a trigger injection and turn up for egg collection about 36 hours later.

There’s another called the Colorado protocol, which is a variation on the antagonist. I don’t have all the details on this and how it’s done in New Zealand, but if someone would like to email me or post it as a comment, that would be a big help!

If you are a poor responder, have high FSH, low AMH, a low antral follicle count, or have been told you have diminished ovarian reserve (DOR), follow this link to check out protocols used for poor responders.

9 Responses to “What are the main IVF protocols used in NZ?”

I am about to start my 6th ivf cycle using the Colorado Protocol. We used this the last time as well (IVF#5) and I have some information here that may be of use to your followers. [We have also tried long protocol and microdose flares.] In summary…. quoted from info received from FS.

Modified Colorado Protocol (The “Wellington”)
“As an adjunct to standard IVF or TER for patients with recurrent implantation failure who have had no problems identified following a recurrent implantation failure screen. The Wellington is a treatment that in theory will improve the lining of the uterus to aid implantation of the embryo”.

Includes taking Aspirin, Prednisone, Augmentin, Progynova as well as the utrogestan in various amounts and for various days before, during and after egg collection and embryo transfer.

Starts off with the BCP. Stop BCP for couple of days and then start Buserelin twice daily 5ug and aspirin (take until 34 weeks pregnant). Two days later start Gonal F and continue until ready to trigger. On day after trigger – start Augmentin (twice daily) and prednisone. Continue both for 5 days. On day after egg collection start utrogestan pessaries and progynova (both taken three times a day). Continue utrogestan pessaries and progynova until 13 weeks pregnant and aspirin until 34 weeks pregnant.

When doing thawed embryo transfer about a week before your next perioid start Aspirin 100mg each day (you can use Astrix, Cartia or Cardiprin all available at the pharmacy). Day of LH surge in a natural cycle or the day you start Utrogestan in a manufactured cycle you start Prednisone for 5 nights, Augmentian twice a day for 5 days and Progynova three times a day. Embryo transfer then takes place.

I just had an embryo transfer yesterday but was put on the Collarado protocol.
I have no idea whether to keep taking the cartia and augmentin or what? I didn’t have a great exp, this is my second go and the team this round aren’t too supportive as was the first team. It’s like perhaps they don’t communicate with each other? I’ve asked and a nurse was supposed to get back to me …. is a bit upsetting.
On phoning to double check when I was to start taking the prednisone the nurse said it hasn’t been proven to give a better chance and she disagreed with it all together but it was a matter of opinion ….. didn’t put me at ease really.

ishtar, please make sure you report this nurse’s comment to your specialist next time you talk. The decision of which protocol to use is one between you and your specialist (though, of course, you are free to ask anyone else’s opinion if you want it).

It is completely inappropriate for a nurse to comment on the suitability of the protocol or whether he/she “believes in it”, etc. I am assuming you didn’t ask this nurse’s opinion. IMHO she is undermining the informed decision you and your specialist have decided on together. What, precisely, makes her think she is qualified to do this? It is clearly against clinic policy/good practices.

This kind of ill-informed comment is every specialist’s (not to mention patient’s) nightmare! The nurse’s job is to follow the instructions and keep you informed of what you should be doing throughout the cycle as per the specialist’s instructions, NOT to engage in armchair theorising and second-guess the advice you have been given by someone who is infinitely more qualified than she is. Please let your dr know about this! And if you get a feedback form to send in after the cycle, note it on there too.

I’m no dr, but my understanding of this protocol is that the augmentin, cartia and prednisone are continued right through the cycle – and several weeks into the pregnancy (depending on your diagnosis and what your specialist or OB advises).

Hang in there; people have had luck with this protocol! I finally had double success (twins!) at age 42 after 6 failed IVFs on the first protocol I included Dexamethasone (a steroid like prednisone). Good luck for the 2ww! 🙂

I’ve just started on lucrin, a drug I have used twice before with good success. I have above average AMH for my age 40yrs and OHSS. The clinic I am with now is doing exactly the same as the overseas clinic as far as dosages go, but are wanting me to stay on lucrin for 21 days before I start puregon. I normally in the past only had 9 to 10 days before starting the puregon, is this of benefit to me as the nurse has informed me thats normal and it fits in with the clinic timing, after previous reassuring me that they would wotk with my own cycle to maximise quality. The nurse has also mentioned that this would be better for an OHSS client in the long run. I thought reducing the estrogen as much as possible was better. This is a long course, there was no contraception pill used leading up to starting the drugs which is manly used to regulate clients through a clinic. I would appreciate you advice.

Mary, I’m not a dr so can’t give medical advice, nor do I know much about the long protocol (being a poor responder myself). Maybe try the Everybody BB (see link to the left under Support BBs) where you’ll be able to compare notes with others who’ve used the protocol.

My limited understanding is that the main concern with long downregulation is oversuppression, but this is typically not an issue for high responders like yourself.